The disappointing performance of conventional public sector reforms in developing countries has led to the rise of ‘new’ approaches seeking to overcome traditional bureaucratic barriers to change: leadership-focused interventions like the Africa Governance Initiative (AGI); accountability-focused initiatives like the Open Government Partnership (OGP); and adaptation-focused models like those of Africa Power and Politics (APP). While these approaches are appealing to aid donors in their promise to move beyond the limitations of purely formal institution building, they fail to provide new answers to the ‘old’ analytical and practical challenges of public sector reform, in particular administrative patrimonialism, public corruption and political capture. The evidence is yet inchoate, but all points to the need for these approaches to work together with conventional ones. Beyond novel implementation tactics, however, there is a need for new strategies of sustained political support for embattled reformers who face powerful incentives against institutional change.